Patent RU-2732098-C1 (RU)
Inventor: IVANOV VLADISLAV VALERIEVICH
IPC: A61B17/00
Filed: 2020-01-14
Granted: 2020-09-11
Abstract: FIELD: medicine. 
     SUBSTANCE: invention refers to medicine, particularly to surgical and plastic surgery. At the first stage, a skin, subcutaneous fat and superficial temporal fascia are incised along a line connecting an external edge of the nose and an external edge of the eye extended to a scalp of the temple at distance of 2 cm from the hair growth line, tissue separation is performed to form a tunnel above a deep temporal fascia to an external eye angle. Further, at the level of upper canine 5–8 mm from the vestibular fold, a mucosal and periosteum incision is made, followed by subperiosteal dissection of tissues in an anterior surface of the upper jaw to a lower-vertebral edge and an external angle of the eye, limited by a medial line drawn from the point of output of the second branch of the trigeminal nerve to the canine, and laterally – by a line extending from outer angle of eye to second minor molar tooth, wherein finger is pressed on point of output of second branch of trigeminal nerve, maxillary nerve with periosteum and adjacent tissues, chewing muscle is not detached, and the circumferential muscle is peeled apart from the attachment point along the lower-vertebral edge. Further, in the area of the external angle of the eye, the subperiosteal space of the middle one-third of the face is interconnected with a tunneled space formed through the temporal approach. At the second stage, two U- or Z-shaped sutures are applied in intra-oral approach in the area of the fatty jaw and in the area of the modiolus; ligatures are brought out through the tunnel into the temporal incision and fixed to a deep temporal fascia. At the suturing points, duplication of the periosteum, subcutaneous fat, superficial fascia to the deep temporal fascia is created, after which through 5 mm-long incision made on the side of the conjunctiva of the lower eyelid, needle with ligature is applied with grasping eye circular muscle in formed subperiosteal space, and then, having captured periosteum of lower edge of circular muscle of eye, needle is again removed into conjunctival incision. At the third stage, the skin, subcutaneous fat in the preauricular and postaural-occipital areas are incised and their limited detachment by 2 cm in the subcutaneous layer, wherein the medial dissection boundary is limited by a line drawn through the outer edge of the iris – the outer corner of the mouth, the lower dissection limit passes at 3 cm below the ramus of mandible, after which a superficial musculo-aponeurotic system in the region of parotid fascia is incised, crossing preauricular, bilge, Macgregor, auricle-platysmal, chewing and mandibular ligaments, subcutaneous space is used to pierce the superficial musculo-aponeurotic system in the region of Modiolus and the Bichat's fat pad and the ligature are fixed laterally to the arcus zygomaticus, sutures are then superimposed on a superficial musculo-aponeurotic system along a line from the outer angle of the eye to the ear lobe. At the fourth stage, the platysma is cut off from the superficial musculo-aponeurotic system within the angle of the lower jaw and fixed with U-sutures to the mastoid and posterior edges of the sternocleidomastoid muscle. At the fifth stage, excess skin is excised, the wound is closed with a two-row suture. 
     EFFECT: method provides higher safety, radicality and stability of correction of age-related face changes with preservation of individual traits and facial expression. 
     1 cl, 2 dwg, 1 ex